Group think? Questioning the individual global health expert
Authors: Sapna Desai, Sabina F Rashid
Journal: The Lancet Global Health (2023)

Why does the myth of the individual expert in global health persist? As two public health specialists based in Delhi and Dhaka, we find that ongoing conversations on decolonisation can benefit from questioning this very idea, rather than accepting the current consensus—or group think—around expertise. Our reflections emerge from two decades' working in grassroots and national settings in south Asia, alongside international engagement. In our experience, expertise in international research teams is measured primarily by the methodological contributions that each individual offers to study design and analysis: the epidemiologists, the anthropologists, or the economists, who then fall into their own hierarchy within the team. This ladder is further subsumed into the privilege that accompanies geographical location—northern, southern, national capital, or rural district. As we see it, prevailing ideas of expertise in global health research neglect three elements. The first element is context: a deep understanding of the environment in which one's work is situated. Health is well accepted to be shaped by the environment, complex politics, and local social fabric—and the variation in these.1Cash R Patel V Has COVID-19 subverted global health?.Lancet. 2020; 395: 1687-1688Summary Full Text Full Text PDF PubMed Scopus (167) Google Scholar By extension, a clear recognition of context should be crucial to every step of the research process. For example, social mapping, which is widely used in rural areas, failed in a Dhaka slum that was facing imminent eviction. We learned that applying universal methods required an equally strong understanding of local politics along with appropriate timing.2Rashid SF Accessing married adolescent women: the realities of ethnographic research in an urban slum environment in Dhaka, Bangladesh.Field Methods. 2007; 19: 369-383Crossref Scopus (19) Google Scholar In India, quantitative data analysis on hysterectomy in rural Gujarat presented more puzzles than clear patterns, until community health workers suggested unique, context-specific questions on household attitudes towards menstruation and agricultural labour.3Desai S Sinha T Mahal A Prevalence of hysterectomy among rural and urban women with and without health insurance in Gujarat, India.Reprod Health Matters. 2011; 19: 42-51Crossref PubMed Scopus (34) Google Scholar As Ramani and colleagues argue, nuanced reflection on these connections requires context beyond what is commonly considered expertise, particularly if research is to influence policy or programmes aligned with lived realities.4Ramani S Whyle EB Kagwanja N What research evidence can support the decolonisation of global health? Making space for deeper scholarship in global health journals.Lancet Glob Health. 2023; 11: e1464-e1468Summary Full Text Full Text PDF PubMed Scopus (6) Google Scholar We need strong methodologists, wherever they live; but, equally, methods need context. Context requires individuals to travel the distance, physically and metaphorically, to move beyond imagined field sites and see health within its broader environment. Second, practice. Knowledge hierarchies typically exclude practitioners of public health or relegate them to stakeholders or implementers who are cursorily consulted rather than actively engaged. No training can match what we have learned through practice, such as being confronted with a woman in a reproductive health camp who consumed a vaginal suppository because it had no instructional diagrams. Practice takes many forms. The expertise of a community health worker, an administrator, and policy maker are essential to high-quality research design and implementation. Yet, they too often are missing from formal inclusion in research teams or academic teaching positions. Recently, we halted a co-developed course on public health problem-solving in Bangladesh, because the western academic partner did not want to recognise practitioners with 20 years' experience were on par with academic faculty. The problematic assumption that practitioners cannot be experts supports a persistent hierarchy of what constitutes knowledge. Third, lived experiences. We increasingly see multidisciplinary teams in global health, but engagement with communities who are directly affected by the research issue can remain on the surface. Collaboration loses its meaning when it avoids a key question—does the collaborative approach go beyond the assumption that the local partner institution brings context, in place of those directly affected? Partnering with diverse actors as knowledge bearers is not a project book end dissemination or feedback workshop; it requires a humble commitment to ensure the right people have an adequate say in methods and interventions being planned. The persistence of group think around the individual expert is reflected in the visibility, ownership and leadership of research. In reality, global health thrives on collective expertise, with multiple knowledge bearers. Building on important calls for redistribution to promote equitable leadership in global health,5Ojiako CP Weekes-Richemond L Dubula-Majola V Wangari M-C Who is a global health expert?.PLoS Glob Public Health. 2023; 3e0002269 Crossref PubMed Google Scholar we argue that the very idea of individual expertise requires rethinking. For real improvements in public health, the field will need a healthy dose of humility to move beyond the predominant language of individual expertise and one-way capacity building to recognising joint knowledge building, leadership, and contributions. Acknowledging collective expertise begins with simple terms, from meeting times that do not revolve around one time zone, to the complex negotiations extensively written about to ensure equity in global health research, publishing, teaching, and practice. When we begin with the concept of collective rather than individual expertise, research teams might see what is gained from equitable partnerships, such as a wider lens on complex health issues and methodological diversity. Resources and time are obvious requirements for such an approach, but recognising shared expertise from the outset can avoid common pitfalls. There are examples of such approaches and institutional partnerships, but these are not yet the norm. Accepting collective expertise will require uncomfortable self-reflection, creating space, and increasing accountability6Pai M 10 fixes for global health consulting malpractice.https://globalhealthnow.org/2019-08/10-fixes-global-health-consulting-malpractice#:~:text=The%20ultimate%20solution%20is%20to,or%20controlled%20by%20HIC%20experts%3FDate: Aug 12, 2019Date accessed: June 30, 2023Google Scholar to ensure authentic partnerships. We declare no competing interests.